Community Engaged Learning in a metropolitan setting for medical students' accountability development

Introduction
Despite established evidence on the importance of meaningful community engagement in creating socially accountable medical graduates, most initiatives have been limited to rural areas even though more doctors practice in urban settings. Other initiatives are limited to segments of student cohorts, often those who are already interested in social accountability. The Medicine in Context (MiC) program at Western Sydney University School of Medicine (WSUSoM) uses Community-Engaged Learning and Partnership Pedagogy as key approaches to promote social accountability amongst all medical students through strong partnerships with under-served suburban metropolitan communities and service providers.

Methods
The MiC curriculum embeds compulsory Community-Engaged Learning elements into the first three years of a 5-year Doctor of Medicine course. The MiC Team co-develops, co-delivers, co-assesses and co-evaluates the teaching program with community partner organisations. Underpinned by experiential learning and spiral curriculum, all students are immersed in community services to understand first-hand where their patients come from. Community facilitators co-deliver MiC teaching activities emphasising links between medical practice, social determinants of health, and local community contexts.

Evaluation
The MiC program components of teaching activities and placements have been continuously positively evaluated by the students and community partners organisations. Students state that community placements are a major strength of the WSUSoM’s medical program which is “universally appreciated by the students.”

Discussion
The MiC model demonstrates how a Community-Engaged Learning curriculum is feasible for metropolitan settings where most medical schools are located. Students learn to analyse and reflect on how to integrate patient and community contexts into clinical practice. Bilateral commitment from local communities and the School of Medicine is critical. Creating embedded, compulsory curricular spaces for Community-Engaged Learning is key to produce socially accountable medical graduates. Challenges include improving buying-in from students, working with the dynamics in the community health and not-for-profit sectors, and securing adequate resources.